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Updated: May 29, 2025

Method of Studying Palatal Fusion using Static Organ Culture
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Characterizing age at velopharyngeal dysfunction in patients with cleft palates.

Kaamya Varagur1, Sophia Chryssofos1, T Owen Douglas1

  • 1Division of Plastic and Reconstructive Surgery, Washington University in St. Louis, St. Louis, MO, United States.

Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS
|February 7, 2025
PubMed
Summary

Many patients with cleft palate experience velopharyngeal dysfunction (VPD) requiring surgical intervention after age 6. Continued speech evaluations are crucial through adolescence for optimal outcomes.

Keywords:
Cleft palatePalatoplastyPharyngeal flapSpeech outcomesSphincter pharyngoplastyVelopharyngeal dysfunction

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Area of Science:

  • Craniofacial surgery
  • Speech pathology
  • Pediatric otolaryngology

Background:

  • Velopharyngeal dysfunction (VPD) after palatoplasty is typically assessed in young children.
  • This study investigates the ongoing risk and management of VPD in cleft palate patients beyond age 6.

Purpose of the Study:

  • To analyze the incidence and timing of velopharyngeal dysfunction (VPD) treatment in patients with cleft palate beyond the age of 6 years.
  • To evaluate trends in surgical interventions for VPD over a 40-year period.

Main Methods:

  • Retrospective analysis of a 40-year institutional cohort of patients with cleft palate and VPD.
  • Inclusion criteria: age ≥13 years at follow-up, documented VPD requiring surgical intervention.
  • Survival analysis was used to determine age at treatment and compare repair types and time periods.

Main Results:

  • 51% of 94 surgically treated patients received interventions after age 6.
  • Secondary palatal re-repair (median age 12.1 years) differed significantly from pharyngeal flap/sphincter pharyngoplasty (median ages 4.8/5.2 years).
  • Repair type proportions shifted significantly over time, with reduced sphincter pharyngoplasty and increased palatal re-repair.

Conclusions:

  • A substantial number of cleft palate patients require secondary palatoplasty for VPD beyond age 6.
  • Regular speech evaluations into adolescence are vital for managing velopharyngeal function.
  • This underscores the long-term nature of velopharyngeal issues in cleft palate care.